title: Volume-based trends in surgical care of patients with oropharyngeal cancer.
abstract: OBJECTIVE
  Positive volume-outcome relationships exist for diseases treated with technically complex surgery. Contemporary patterns of oropharyngeal cancer surgery by hospital and surgeon volume are poorly defined.
  
  
  METHODS
  The Maryland Health Service Cost Review Commission database was queried for hospital and surgeon oropharyngeal cancer surgical case volumes from 1990 to 2009.
  
  
  RESULTS
  Overall, 1,534 oropharyngeal cancer surgeries were performed by 238 surgeons at 41 hospitals. Cases performed by high-volume surgeons increased from 18.9% in 1990 to 1999 to 24.8% in 2000 to 2009 (odds ratio [OR] = 1.5, P = .002), whereas cases performed at high-volume hospitals increased from 35.0% to 41.8% (OR = 1.7, P <.001). High-volume surgeons were significantly associated with university hospitals (OR = 25.9, P < .001) and were more likely to perform partial glossectomy (OR = 1.8, P = .002), total glossectomy (OR = 3.8, P < .001), and neck dissection (OR = 2.3, P < .001). High-volume hospitals were significantly associated with tonsillectomy (OR = 3.0, P < .001), partial glossectomy (OR = 1.4, P = .044), total glossectomy (OR = 4.3, P < .001), neck dissection (OR = 3.1, P < .001), flap reconstruction (OR = 1.9, P = .028), and prior radiation (OR = 5.0, P < .001). After controlling for other variables, oropharyngeal cancer surgery in 2000 to 2009 was associated with increased utilization of university hospitals (OR = 1.7, P < .001), increased mortality risk scores (OR = 3.1, P = .022), prior radiation (OR = 4.9, P = .011), and a decrease in partial glossectomy (OR = 0.5, P < .001), total glossectomy (OR = 0.4, P = .004), pharyngectomy (OR = 0.6, P = .007), and mandibulectomy (OR = 0.6, P = .022) procedures.
  
  
  CONCLUSIONS
  The proportion of oropharyngeal cancer surgery patients treated by high-volume surgeons and hospitals increased significantly from 1990 to 1999 to 2000 to 2009, with a decrease in partial glossectomy, total glossectomy, pharyngectomy, and mandibulectomy procedures. These findings may be due to changing trends in the primary management of oropharyngeal cancer.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. cgourin1@jhmi.edu
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
authors.forename: Arlene A
authors.initials: AA
authors.lastname: Forastiere
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sanguineti
authors.forename: Shanthi
authors.initials: S
authors.lastname: Marur
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Koch
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D005544:Forecasting; D005927:Glossectomy / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008396:Maryland; D008875:Middle Aged; D037981:Neck Dissection; D020360:Neoadjuvant Therapy; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D017063:Outcome Assessment, Health Care / Q000639:trends; D010611:Pharyngectomy; D013524:Surgical Flaps; D014062:Tongue Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D014068:Tonsillectomy / Q000706:statistics & numerical data; D014600:Utilization Review / Q000639:trends; D055815:Young Adult